Actual Practices in Nephropathology: A Survey and Comparison with Best Practices

3 Renal pathology is a specialized field requiring sophisticated tissue evaluation by light, immunofluorescence (IF) and electron microscopy (EM). There are published suggestions for best practices in this area, but actual practices may vary relative to location and need for cost containment. To evaluate the practice of nephropathology, 120 questionnaires regarding tissue handling, processing and staining were distributed to members of the Renal Pathology Society; 75 were returned, some partially completed. Most institutions (71%) reported receiving 16 or 18 gauge core biopsies, examining 9 slides for native kidneys, 8 slides for transplant kidneys, and using hematoxylin and eosin, periodic-acid Schiff, trichrome and silver stains. Given adequate native kidney biopsies, most institutions (85%) always collected tissue for light, IF and EM, while 15% would not collect for IF or EM based on clinical input. Ninety-four percent always performed IF on adequate native kidney samples; those from Europe did IF more often in the absence of glomeruli. A minimum of 8 antibodies, including both light chains, was used by 70%. EM was always done on native kidneys by 51%, and was conditionally done by the remainder based on specimen adequac